January 2005 – Present Life and Health Customer Service Agent/Human Resource Generalist

The Customer Service Agent (CSR) for the alphabetical split of M-Z. Responsible for the general customer service to the group administrators as well as assisting with administrative issues, claims questions and/or issues, and general customer service to group administrators.Sell individual medical, life and dental policies to the individual market place.Act as consultant to key employees and brokers on all benefit issues. Analyze and research details of benefit plans and contracts, COBRA administration, administration of medical insurance (including PPO, POS, HMO, and Self-Insured Plans).Negotiate and resolve claim and policy discrepancies between insurance carriers and health providers.

Create the benefits to be posted on our internal intranet, ongoing revision of the employee manual and answering any other questions related to our company benefits.

Responsible for providing health claims customer service to participants, union locals and providers regarding eligibility, benefits and claim status.Provided telephone customer service support by responding to and documenting telephone and written inquiries.Set up claims to be re-opened; process check tracers, stop payments, and claim audits.

The Account Coordinator is responsible for the general day to day servicing of groups, which included assisting with administrative issues, claims questions and/or issues, and general customer service to group administrators. Preparation of renewal notifications and timely distribution.Provided group status information to sales management. Where Large Group uses Benefits Specialists, the Small Group position required both account coordination and direct customer service.

September 2000 – June 2002 Benefits Specialist

Served as an expert benefits consultant coordinating employee benefit eligibility transactions, administering the health and welfare benefit programs for employer groups with 50+ employees. Benefits Coordinator for four marketing teams. Consultant to key employees and executives regarding all benefit issues. Analyzed and researched details of benefit plans and contracts, COBRA Administration, administration of medical insurance (including PPO, POS, HMO, and Self-Insured Plans).Negotiated and resolved claim and policy discrepancies between insurance carriers and health providers. Advised and consulted with clients and their employees at Open Enrollments presentations and Benefit Fairs.

Duties included service and renewal activities in support of increasing and retaining membership by providing support to sales and service staff using standard policies, procedures and guidelines. Scheduled periodic service calls with employer groups to include group presentations, question and answer sessions and present PacifiCare products at open enrollment meetings. Assisted sales and service staff in contract renewals, upsales and new sales. Gathered census information and prepare renewal rate proposal letters.

QualMed Health Plan, Bellevue, WA(7 years)

October 1996 – July 1998 Assistant Underwriter

Duties included preparing and completing small group renewals and quotes, performing large group renewals using ACR rating methodology, negotiating and strategizing final renewal rates and completing work-ups on large renewals and quotes for Underwriter I and II.Provided sales with requested alternate benefit design costs and experience reports.Knowledgeable of small and large group legislation for Washington, Oregon and Idaho. Held sole responsibility for BDS reporting for senior management.Performed and released life quotes.

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